Specialty Care

Secondary Infertility

 A diagnosis of secondary infertility may be rendered if:

  • A couple who have already given birth without the use of medical support or fertility medications finds themselves unable to get pregnant or experiences recurrent miscarriages and
  • They have been trying for one year if the woman is less than 35 or
  • They have been trying for 6 months if the woman is older than 35

Whatever the underlying causes for a woman’s difficulty conceiving, talking with a specialist is the best way to untangle a web of confusing information and emotions; including the helpful “advice” from friends and family and the myriad ways people blame themselves when things don’t go as planned.

To learn more visit RESOLVE.org

The Possible Causes of Secondary Infertility

Causes of secondary infertility vary, but there are a number of factors that may be at play.

Advanced reproductive age

The woman’s age is one of the most common reasons for secondary infertility. Although a woman like Claire may have had no problem getting pregnant a few years ago, those interim years can change things. It is critical to understand that a woman is born with all of the eggs she will ever have. As a woman ages, her ovarian reserve will diminish. This means that her egg quantity and egg quality will decrease, while the chance of miscarriage increases. This is true whether or not she conceived easily in the past.

Structural complications

Some other important factors relate to the structures in the pelvis which includes the fallopian tubes. Pelvic adhesions – which may be caused by endometriosis or prior abdominal surgeries – may make it difficult for the egg to be picked up by the fallopian tube. Without a connection that functions normally, pregnancy cannot result.  In addition, if there were complications that developed during a prior delivery and a uterine infection resulted, she may have developed Asherman’s syndrome (intrauterine adhesions) or adhesions that develop around the fallopian tube.

Sperm quality and quantity

The third category to consider is the sperm. Just as a woman’s fertility can change with time, so can a man’s. Changes in sperm quality and quantity may occur due to changes in health or new medications. A semen analysis is one of the basic aspects of the initial infertility evaluation.

Weight gain

Weight can have a huge impact on the ability to conceive.  Excessive weight gain can contribute to ovulatory dysfunction. With increased weight, insulin resistance can increase as well which leads to elevated production of testosterone from the ovaries, a phenomenon that can further prevent normal ovulation.   In men, excessive weight can also negatively affect sperm production by increasing estrogen levels.

Smoking

Cigarette smoking in both the male and female can significantly impair the ability to conceive. And, smoking can seriously impact a woman’s ability to carry a normal pregnancy.

Recommended Treatments

Fertility treatments are constantly improving: pregnancy rates for infertile couples using Assisted Reproductive Technologies (ART) are currently higher than the average monthly fertility rates. Even if you already have a child, if you suspect secondary infertility, seek help from a fertility specialist as early as possible! Early evaluation is critical since, as time passes, certain treatment options may be more difficult to pursue.

Medication

Medications that are used to enhance fertility include oral medications such as clomiphene citrate (Clomid) and injectable gonadotropins. Both are used to increase the number of eggs that are available for fertilization.

Fertilization

Once the eggs are ready, doctor and patient will determine if the best way to proceed is via intercourse, intrauterine insemination or in vitro (in the lab).  In vitro fertilization has been useful in circumventing some of the tubal and pelvic disorders that can cause secondary infertility and is also helpful in increasing rates of fertilization–even if a woman’s fallopian tubes are already opened, as in the case of severe sperm-related abnormalities.

Egg donation

In the case of women who are diagnosed with severely diminished ovarian reserve with no remaining ovarian function, egg donation is an option.